- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $109.65 / $363.08 / $912.01
| Facility | | $109.65 | $363.08 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $162.18 / $489.78
| Professional | | $75.86 | $162.18 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $83.18 / $169.82 / $380.19
| Professional | | $83.18 | $169.82 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $83.18 / $562.34
| Professional | | $74.13 | $83.18 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $389.05 / $1,122.02
| Facility | | $208.93 | $389.05 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- 52
- Typical Low / Median / Typical High
- $100.00 / $100.00 / $100.00
| Facility | 52 | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $85.11 / $154.88 / $354.81
| Professional | | $85.11 | $154.88 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $147.91 / $190.55 / $323.59
| Professional | | $147.91 | $190.55 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $338.84 / $416.87 / $524.81
| Professional | | $338.84 | $416.87 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $81.28 / $169.82 / $371.54
| Facility | | $81.28 | $169.82 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $151.36 / $151.36 / $831.76
| Professional | | $151.36 | $151.36 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $75.86 / $117.49 / $281.84
| Facility | | $75.86 | $117.49 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $281.84 / $630.96
| Professional | | $173.78 | $281.84 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $575.44 / $2,041.74
| Facility | | $61.66 | $575.44 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $154.88 / $363.08
| Professional | | $74.13 | $154.88 | $363.08 |